Friday, 16 July 2010

Putting Theory into Practice: Lingam, The Little Boy in the Hospital...



I've been visiting a child by the name of Lingam* in the hospital.

He reminds me very much of Chee Keong--under the care of Jabatan Kebajikan, sick, stays for months at a go in the hospital, insists on his way with the nurses and they happily oblige, the whole ward seems to know him in some way, and his bedside table is filled with little things that parents and nurses will buy or bring for him. Clothes (mostly used), cookies and treats, little toys.


The only differences are, Lingam is five, and can talk. Unlike Chee Keong who was developmentally very delayed, and too sick for words, Lingam is able to talk to me.


So I visit him and look at picture books with him, give him little wet-sponges cos he recently got a catheter and some IV attached and I didn't want to risk infecting it, and helping him eat lunch (cutting his chicken, urging him to eat vegetables, cleaning his face and hands after eating, etc).

But I also know I'm leaving again soon and don't want to get tooooo attached. And since Lingam is aware of things and knows perfectly well how to miss a person, I don't want him to get attached too. So I visit him about once a week, and when I leave, tell him to expect me the following week ("Arrr, ok", he says, with a head bob).



I've popped in unplanned a few times where he is sleeping, so I stroll back out as I don't fancy waking a child up.

Like Chee Keong, Lingam knows how to throw a tantrum too; unlike Chee Keong, however, he is verbal.



If there is anything I learnt about behaviours and Psychology, it's that children who throw a tantrum basically are trying to solve a problem, but they lack the skills to problem-solve (incidentally, so do adults who throw tantrums). And if you reward tantrums by giving in, or even paying attention to it, it will magnify.

It's a process of Positive Reinforcement for the one throwing the tantrum, and Negative Reinforcement for the one giving in (cos the caregiver's rewarded by having the child stop the annoying whining and screaming).



So as he whines and gives me his crocodile tears, I tell him firmly "Lingam kena berhenti jerit, baru Aka cakap dengan Lingam" (You have to stop screaming, and then we'll talk). I then completely ignore him untill he stops, which is pretty quick. The minute he stops, I give him a big smile and shower him with praise.

So, reward the stop-whining, not the whining.



Reward and punishment are surprisingly effective, when done right--there are some rules for effective punishment. Alot of people think punishment means smacking, grounding etc. Not necessarily. A statement such as "I don't like that behaviour" or "what you did is bad" is pretty effective too (NEVER say "I don't like you" or "you're bad"), something known as Positive Punishment. Punish the behaviour, NOT the person.



You can also try Extinction, which is more what I'm doing, because with multiple caregivers with different behaviours, punishment is not going to be effective.


In Lingam's extinction, what I did was basically remove the reinforcement (i.e., attention, his way etc) he was always receiving when he whines. Since he was always getting his way by throwing a tantrum, me refusing to give in is in fact me setting him on extinction (at least, a context-based extinction). Eventually, he is going to stop whining, at least with me.



Lol. I'm spending time with a child in the hospital, and I'm also putting theory into practice...

But punishment must be coupled with reward. So I'm going to bring colour-pencils and crayons (and some colouring material that one of the physiotherapists passed to me very happily) for Lingam next week who asked to colour.



Note: *Name has been changed.




6 comments:

Jeryne said...

is there a time when you are not doing something? your , passion and dedication to what you love really amazes me. all i do during my holodays is chill.

Anonymous said...

I have read your blog from long time ago. I just did not leave a comment.

Won't he get attached Daphne? And you to? It's great you think of how to use your skills and knowlege! I am in Psycho too, and I did not think of it.

Passaby

whre4arthou said...

Hello Nai,

Yes, the whole reward the stop whining and not pay any attention to the whining thing works wonderfully but not when everyone else around the child is not consistent with it.

Although I do realise that if I am consistent with it the children behave better when they're alone with me.

I just hope I'm not being too harsh with them.

Are you using Jo Frost's techniques? Hehe..

Daphne Ling said...

Hi Jeryne,

I am a self-professed pig. I spend a lot of time sleeping and eating. Ask mum! ;)

Daphne Ling said...

Hi Anon 02:38 @ Passaby,

Thanks for leaving a comment then. That's why I'm visiting him every now and then, to make sure neither of us gets attached.

At the same time, I'm still going in and sitting/playing/reading with/to him so he has a couple days where he isn't bored to death.

Lol. It's been a while since I heard the word 'Psycho'. Everybody there says 'Psyc'. Guess the public perception of the field of mental health does affect quite a bit, even to the extent of how it's called!

Hmmm...

Daphne Ling said...

Hi Ae Mi,

Ah, good point! For any form of punishment to be effective, there has to be consistency. Otherwise, it becomes context-dependent or person-dependent.

I.e., I only behave when X is around.

It can also potentially not work at all!

But for the child to be consistently behaving, there definitely has to be consistency!

And no, am not using Jo Frost's techniques. I am using behavioural techniques, which is where I am pretty sure Ms. Frost gets hers! It's classic behavioural!